AB0328 ASSESSING THE MULTIMORBID PROFILE (CIRS) IN REFRACTORY RHEUMATOID ARTHRITIS
Authors: A. Gordeev, E. Galushko
Journal: Annals of the Rheumatic Diseases (2022)

Background The World Health Organization assigns cardiovascular diseases, cancers, chronic respiratory diseases, as well as diabetes mellitus and some other nosological entities, including mental and musculoskeletal disorders, to main non-communicable diseases. These are considered to be a major public health challenge of the 21st century. In this case, one patient frequently has a set of several age-related chronic diseases that develop simultaneously or sequentially. The management of these patients requires an integrated approach based on the multimorbid nature of pathology. Unlike the definition of comorbidities, which assumes to identify the underlying and related diseases, the concept of multimorbidity of such gradations fails to provide and interprets a patient’s chronic diseases as equivalent. Objectives To assess the presence and nature of multimorbidity in patients with refractory rheumatoid arthritis (RA) and the impact of multimorbidity on disease activity Methods The investigation enrolled 153 patients (mean age, 54.8±14.8 years) with RA according to the 2010 ACR/EULAR criteria, who had been examined and treated at the V.A. Nasonova Research Institute of Rheumatology in 2019–2020. The median disease duration was 5.7 [1.5; 10.5] years; the mean DAS28 score was 5.0±1.3. Documentation and anamnesis data were analyzed with emphasis on associated diseases. The Cumulative Illness Rating Scale (CIRS) was used to assess the profile of multimorbidity. Results The patients with RA had a high index of the spectrum of multimorbidity; concomitant diseases were detected in 125 (82%) patients with RA. Their number ranged from 0 to 8 and increased in direct proportion to the age of the patients. The average total score of CIRS was 6.7 ± 3.3 points, the maximum score was 18, the minimum score was 2; The multimorbidity index is 2.5 [1; 6], the maximum number of categories with a score of ≥2 points is 6, the minimum is 1. The number of concomitant diseases diagnosed in patients with RA before using CIRS was significantly lower (by 52%; p &lt;0.01) than the results of our study showed. Most often, the following disorders were observed in patients at the time of inclusion in the study: comorbid cardiovascular diseases in 44%, anemia in 14.5%, hypercholesterolemia in 18%, obesity in 9.5%, thyroid disease in 11.5% (hypothyroidism criterion – in 3.5%) and diabetes – in 4%. CIRS allowed the first time to identify chronic pathology. The results reflect the cautiousness of doctors regarding comorbid cardiovascular diseases in RA: only 4% of patients were diagnosed with hypertension for the first time. At the same time, before inclusion in the study, no patient with RA revealed chronic kidney disease(CKD), which occurred in almost half of the cases (44.5%). On average, every third person had no previous signs of metabolic syndrome (hyperclycemia in 29%, obesity in 13.5%) and chronic hypoxia (anemia first diagnosed was verified in 24% of cases) There was a correlation of the quantitative equivalent of multimorbidity with the clinical and laboratory measures of RA activity, including the number of painful joints (r = 0.39; p&lt;0.001), overall patient assessment (r=0.37; p=0.03), physician’s global assessment of disease activity (r = 0.37; p &lt; 0.01), DAS28 (r = 0.42; p&lt;0.001), CDAI (r=0.37; p&lt;0.001), SDAI (r=0.34; p&lt; 0.001), HAQ (r=0.34; p&lt;0.001). Conclusion Systematic screening for multimorbidity should be performed in each patient with RA. It is advisable to use CIRS in subsequent studies to assess the prevalence of multimorbidity and its consequences. CIRS allows you to more accurately determine the contribution of each chronic disease or syndrome to the development of «multimorbid disease» References [1]The study was carried out within the framework of topic No. АААА-А19-119021190149-0 Disclosure of Interests None declared